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Chronic viral hepatitis B & C in ethnic migrants: a controlled randomised cross-sectional cluster trial to assess the impact of identifying, screening, and treating immigrants with viral hepatitis

Centre for Psychiatry

Overview

Chronic viral hepatitis (persistent infection with either hepatitis B or hepatitis C) causes an asymptomatic disease that leads to cirrhosis and death in a large proportion of those who are infected. These asymptomatic diseases are often not associated with abnormalities of liver function tests precluding identification by simple non-specific testing. The prevalence of viral hepatitis is at least ten fold greater in immigrants than in the indigenous community (prevalence in the UK is ~0.5% but > 5% in immigrants) and there is abundant data (from the Health Protection Agency and liver transplant programs that the mortality and morbidity in ethnic minorities is growing rapidly. Early identification of people with chronic viral hepatitis allows effective therapy, shown by NICE to be highly cost effective. Given the rising mortality in ethnic minorities from chronic viral hepatitis the Advisory Group on Hepatitis and The National Screening Committee have considered screening in immigrants but there is no data on whether this is feasible and clinically/cost effective.

The UK has one of the lowest rates of therapy for viral hepatitis in Europe and this is undoubtedly contributing to the rising mortality from liver disease in the UK (mortality is falling in the rest of Europe). UK studies have shown that access to therapy for patients known to have viral hepatitis is poor with only a tiny minority of diagnosed patients going on to receive treatment. Strategies that improve access to treatment are likely to have a major impact on treatment uptake but alternatives to hospital based treatment have not been studied.

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